Membership By Transplant Only

My personal & professional journey

Photo by David Walker on Unsplash — Give Back

I was a senior in nursing school when my older daughter had her liver transplant. She was 12. The nearest pediatric liver transplant center was in Pittsburgh, a seven-hour drive from our home in Upstate NY. And also, my introduction to the world of solid organ transplant.

When I became a nurse, I thought I might go into pediatrics, after all, I had been my daughter’s caregiver throughout her ordeal and I figured if I could take care of my own critically ill child, other people’s kids would be way easier. Plus I wanted to give back, to honor the truly amazing nurses we had after her surgery.

The Universe had other plans.

Nursing jobs were scarce when I graduated in 1994. I managed to cobble two part-time jobs together to work full-time hours but I had no benefits. It didn’t matter much as the following year we moved to North Carolina where I landed a full-time position in the critical care service and began my 26-year-long career at a level one trauma center.

Some of my favorite patients were kidney transplant patients. They usually came straight from the recovery room to our ICU step-down. The patients were usually feeling pretty good after their surgeries. Their anesthesia hang-over was keeping them fairly comfortable, along with their pain medications. The fact that they now had a functional kidney that was working hard to come back online and remove all the toxins in their blood was also in play. Mostly, it was the kidney that needed the careful monitoring post-op, not so much the whole patient. I used to joke that the kidney went to the ICU after the transplant, and the recipient came along for the ride.

In my time in the critical care service, I would also work in the surgical ICU and take care of fresh liver transplant patients. They would come to us still intubated with multiple drugs being pumped into their central lines. They were challenging patients but I was well aware of what their families were going through and I could feel myself settling into that sacred space of giving back. Occasionally, I would share that my daughter had a liver transplant and although the first year post-op was rather complication-prone, she had survived and resumed a normal life. The gratitude that was shown back in the eyes of transplant families was breathtaking. Even now, just remembering this brings tears to my eyes. They knew then that I was one of them. That I understood. That we belonged to the Membership By Transplant Only Club and that I had their backs.

Burnout is endemic in nursing. After three years in the ICU, I had to leave for my own mental health’s sake. Eventually, I would land in the Operating Room (OR) Nurse training program and move to the OR. Once there I joined the team who did heart, lung, vascular, and transplant surgeries. After a bit, I became the team lead of the solid organ transplant service. I had also been trained to do heart and lung transplants, so I would sometimes be on call for those transplants as well. But mostly, I spent my time plugging in new livers, kidneys, and the occasional pancreas. I also got really good at removing those organs — either from a deceased donor or in the case of livers and kidneys, from living donors.

We did a few living donor liver transplants, but it was a big surgery for the donor and there was ongoing controversy regarding quality of life after donation. I noticed we only rarely did this type of surgery. But we scheduled living donor kidney transplants every Friday.

In a living donor kidney transplant, two ORs are used — one for the donor and one for the recipient. In our facility, the rooms we used, were side by side with an anteroom between them. The kidney donor went back to their OR first and at the point in time their team was almost ready to remove the kidney — we would then bring the recipient back into the adjoining room and start their surgery.

Once the surgeon in the recipient room got to the place where he/she/they were ready to install the kidney, they would give the donor room the okay to remove it from their patient. The kidney was removed, flushed with an ice-cold sterile solution, placed in a kidney basin, on sterile ice, and covered with a sterile towel. One of the donor’s surgeons, with the help of the circulating nurse (who opened & closed doors), would then walk the kidney over to its new home — all the while maintaining the sterility of the traveling kidney and their person. Once back in the donor room, the transporting surgeon would re-gown and glove to maintain the sterile field in the donor room and assist with closing.

After surgery, the donor would go to the recovery room and then on to their room on the transplant floor. The recipient would go along as the newly transplanted kidney went to an ICU where it would be closely monitored. A newly transplanted kidney is rather traumatized by the whole process so it requires a lot of TLC. Caring for a new kidney transplant patient involves a lot of intensive nursing care. For instance we did hourly urine outputs and ran massive amounts of fluids into the recipient. Often the recipients were diabetics who also required hourly blood sugar checks and frequent labs. And strict documentation of all of the above. Hence, the ICU — where a nurse had the ability to pay close attention to the freshly transplanted kidney and make sure it settled gently into its new habitat.

Usually, the recipient felt great, but the donor was in for a couple of really tough days. Our bodies don’t realize they have been traumatized on purpose when we have surgery. And a perfectly healthy body was just subjected to the trauma of having a kidney dug out of its flank. The chemicals released are the same ones released whenever we are injured or sick. Our immune system response to an assault on our body doesn’t soften simply because we signed a consent form for this trauma.

After six years in the OR, I took a position as a kidney transplant coordinator. I took over from the woman who had started our living donor program. In this role, I would be the donor’s advocate. About half the time, we would find some here-to-fore-unknown disease process in the donor and it would rule them out. However, it also saved their lives. Undetected cancers, hepatitis, and HIV were less common than high blood pressure, diabetes, and kidney stones. For this reason alone, donors were required to have health insurance in place, just in case the donor work-up diagnosed a pre-existing condition. The recipient’s insurance paid for the donor evaluation, surgery, and hospital stay. Keep in mind, these were the days before the Affordable Care Act when insurance companies could routinely disqualify and refuse to cover anyone with a pre-existing condition.

The living donor work-up consisted of roughly three visits worth of testing. The first visit would be blood and urine tests as well as a visit with our social worker and psychologist. I would also see the potential donor in our clinic and begin the education process. If all went well with that first visit, the potential donor would be brought back for more extensive testing on their second visit — ultrasound, chest x-ray, and 24-hour urine collection. Their final visit would be a CT scan to assess the vascular system that connected their kidneys to their aorta. The decision on which kidney to donate would be based on this scan. The surgeons liked to take the left kidney and transplant it on the right side of the recipient’s abdomen. Most of the time, the recipient’s malfunctioning kidneys were left in place.

I always told donors that they would feel like crap after surgery and to be mentally prepared for that. Some believed me, but most did not. Until I visited them the day after the surgery in their rooms. The toughest ones were the moms who donated to their kids. Those women would see me come into the room and demand to be taken to the ICU to visit their children — it never mattered how old those ‘children’ were. I would hunt up a wheelchair and off we would go. I considered it part of their recovery. Nearly all of the moms felt better after laying eyes on their recipients. The trip tired them out, but I know they rested easier and needed less pain medication after our sojourn.

Living donors are followed for two years after donation by UNOS (United Network for Organ Sharing). Our facility had protocols in place and part of my job was making sure my donors were doing okay in those years after surgery. I had a good rapport with my patients and an impressive 95% compliance rate with my post-op donors as far as their follow-ups went. My facility had a policy in place where our department would pick up the cost for post-op monitoring if that was an obstacle for the patient. I was always so proud of the mindset of our department and the support they gave to all our patients.

I worked as a kidney transplant coordinator for over six years before the burnout again hit me. I found myself missing the OR and eventually took a job in our day surgery department. I know I have been blessed in my career in transplant to have worked with some of the finest surgeons, nephrologists, and nurses on the planet. In a stroke of irony that only The Universe could arrange, one of the transplant fellows who had operated on my daughter in Pittsburgh moved to North Carolina. I got to work side by side with a physician I had deeply respected when he was in training. Now, a board-certified transplant attending, he has become one of my very favorite Humans on the planet. Not only for saving my daughter’s life, but because he was kind, respectful, and skilled at his craft.

Back when I started nursing school, I never saw myself devoting a career to transplant surgery. But in the end, that is exactly what I did. In our Human condition — the desire to give back runs deep. Most of us are kind, respectful, and dedicated beings. It is when I look at my career from the rear-view mirror, I understand just how unimportant so many things are. Things that we give value to that don’t enrich our lives. But when we give back something deep within us smiles. We feel lighter. We care less about the dramas that surround us.

We have done what we could, with what we have, where we are. And if that has made life a bit easier for others, we are well and truly blessed.

Namaste.